The OIG has issued their Semiannual Report to Congress for the period October 1, 2022 through March 31, 2023.  The report highlights over $1 billion in expected investigative and audit recoveries identified during the first half of FY 2023. The report details the OIG’s ongoing work through investigations and enforcement actions which include:

• $200 million in recoveries from audits
• $892 million in expected investigative recoveries
• 345 criminal actions
• 324 civil actions
• 1,365 excluded individuals

The types of issues identified that contributed to the $1 billion in expected recoveries include:

• COVID testing related schemes
• Opioid related fraud
• Improper risk adjustment coding
• Improper billing of the following types of services:
  • Advance care planning
  • Epidural steroid injections
  • Facet-joint interventions
  • Co-surgery and Assistant-at-surgery
  • Durable Medical Equipment (DME)
• Prescribing medically unnecessary items/services

We recommend reviewing the Semiannual Report in its entirety to identify risks that are pertinent to your organization.  Identified areas of risk should be evaluated as part of your compliance program’s auditing and monitoring efforts.

The Semiannual report can be found here: https://oig.hhs.gov/reports-and-publications/semiannual/

We are here to help.  The HBE team is available to assist you with all of your coding, billing and compliance program needs.  We routinely provide compliance partner services to large health systems as well as physician practices. Our services include:

• Risk Assessments
• Coding accuracy review
• Clinical documentation improvement reviews
• Policy and procedure development
• Customized education and training for clinical and administrative staff